Deck 13: Drugs Affecting the Cardiovascular and Renal Systems

Question 1

Patient teaching related to amlodipine includes:

A)Increase calcium intake to prevent osteoporosis from a calcium blockade.
B)Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it.
C)Avoid grapefruit juice as it affects the metabolism of this drug.
D)Rise slowly from a supine position to reduce orthostatic hypotension.

Answer 1

Avoid grapefruit juice as it affects the metabolism of this drug.

Question 2

Despite good blood pressure control, an NP might change a patient's drug from an ACE inhibitor to an angiotensin II receptor blocker (ARB) because the ARB:

A)Is stronger than the ACE inhibitor
B)Does not produce a dry, hacking cough
C)Has no effect on the renal system
D)Reduces sodium and water retention

Answer 2

Does not produce a dry, hacking cough

Question 3

ACE inhibitors are useful in a variety of disorders. Which of the following statements is true about both their usefulness in a particular disorder and the reason for their use?

A)They are useful to prevent stable angina because they decrease the thickening of vascular walls due to decreased modified release.
B)They are useful to prevent heart failure because they reduce remodeling of injured myocardial tissues.
C)Both 1 and 2 are true
D)Neither 1 nor 2 are true.

Answer 3

Both 1 and 2 are true

Question 4

While taking an ARB, patients need to avoid certain over-the-counter drugs without first consulting the provider because:

A)Cimetidine is metabolized by the CYP3A4 isoenzymes
B)Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
C)Both 1 and 2
D)Neither 1 nor 2

Question 5

Which of the following is true about procainamide and its dosing schedule?

A)It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.
B)Gastrointestinal adverse effects are common so the drug should be taken with food.
C)Adherence can be improved by using a sustained release formulation that can be given once daily.
D)Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 6

Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be:

A)Started at about half the usual dosage
B)Not increased over the usual dosage for an adult
C)Given once daily because of memory issues in the older adult
D)Withheld if she experiences gastroesophageal reflux

Question 7

Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:

A)It is a long-acting drug with potential for toxicity.
B)Nitrate tolerance can develop.
C)Orthostatic hypotension is a common adverse effect.
D)It must be taken with milk or food.

Question 8

Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they:

A)Improve insulin sensitivity
B)Improve renal hemodynamics
C)Reduce the production of angiotensin II
D)All of the above

Question 9

Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes:

A)Hemoglobin
B)Serum potassium
C)Blood urea nitrogen
D)Serum glucose

Question 10

Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT:

A)Notify your health-care provider immediately if you have change in vision.
B)Monitor your own blood pressure and pulse daily.
C)Take a hot shower or bath if you feel dizzy.
D)Use sunscreen on exposed body surfaces.

Question 11

A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of the following statements is true about this adverse response?

A)Swelling of the tongue and hoarseness are the most common symptoms.
B)It appears to be related to the decrease in aldosterone production.
C)Presence of a dry, hacking cough indicates a high risk for this adverse response.
D)Because it takes time to build up a blood level, it occurs after being on the drug for about one week.

Question 12

The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test has been ordered. Which is a correct response?

A)Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.
B)Amiodarone damages the thyroid gland and can result in inflammation of that gland, causing hyperthyroidism.
C)Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given.
D)Amiodarone can cause corneal deposits in up to 25% of patients.

Question 13

Larry has heart failure, which is being treated with digoxin because it exhibits:

A)Negative inotropism
B)Positive chronotropism
C)Both 1 and 2
D)Neither 1 nor 2

Question 14

Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate:

A)Widening of the area of infarction
B)Onset of congestive heart failure
C)An electrolyte imbalance involving potassium
D)Renal dysfunction

Question 15

Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it:

A)Decreases the amount of calcium inside the cell
B)Reduces stroke volume
C)Increases the activity of the Na+/K+/ATPase pump indirectly
D)Decreases heart rate

Question 16

Serum digoxin levels are monitored for potential toxicity. Monitoring should occur:

A)Within six hours of the last dose
B)Because a reference point is needed to adjust dosage
C)After three half-lives from the starting of the drug
D)When a patient has stable renal function

Question 17

Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct.

A)Administration to older adults because of reduced renal function
B)Digoxin given with aldosterone antagonist diuretics because of decreased potassium levels
C)Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin
D)Doses between 0.25 and 0.5 mg/day

Question 18

Ray has been diagnosed with hypertension and it is determined that an angiotensin-converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for:

A)Hypokalemia
B)Impotence
C)Decreased renal function
D)Inability to concentrate

Question 19

Laboratory monitoring for patients on ACE inhibitors or ARBs should include:

A)White blood cell counts with the drug dosage increased for elevations above 10,000 feet
B)Liver function tests with the drug dosage stopped for alanine aminotransferase values twice that of normal
C)Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
D)Serum glucose levels with the drug dosage increased for levels greater than 120 mg/dL

Question 20

Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker?

A)Bradycardia
B)Hepatic impairment
C)Increased contractility
D)Edema of the hands and feet

Question 21

When comparing ACE and ARB medications, which of the following holds true?

A)Both may produce a dry, irritating cough
B)Both contribute to some retention of potassium
C)ARBs have a stronger impact on hypertension control than ACE medications
D)ARBs have stronger diabetes mellitus renal protection properties than ACE medications

Question 22

Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be:

A)This is a parasympathetic response to the vasodilating effects of the drug.
B)Headaches are common side effects with these drugs. How severe are they?
C)This is associated with your smoking. Let's work on having you stop smoking.
D)This is not related to your medication. Are you under a lot of stress?

Question 23

Which comment by a patient indicates a need for more education concerning his nitrate medication?

A)"I have several bottles because I live in a multilevel home."
B)"I keep a tablet on the bedside table in case I awaken with chest pain."
C)"I learned not to keep my bottle on top of the fridge because the last one 'cooked' due to the heat."
D)"I read that the old formula of take three every five minutes and call emergency medical services (EMS) is now take two and call EMS."

Question 24

The choice of diuretic to use in treating hypertension is based on:

A)Presence of diabetes with loop diuretics being used for these patients
B)Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range
C)Ethnicity with aldosterone antagonists best for African Americans and older adults
D)Presence of hyperlipidemia with higher doses needed for patients with low-density lipoproteins (LDL) above 130 mg/dL

Question 25

Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug:

A)Blocks synthesis of cholesterol in the liver
B)Exchanges chloride ions for negatively charged acids in the bowel
C)Increases HDL levels the most among the classes
D)Blocks the lipoprotein lipase pathway

Question 26

In teaching about the use of sublingual nitroglycerine, the patient should be instructed:

A)To swallow the tablet with a full glass of water
B)To place one tablet under the tongue if chest pain occurs and allow it to dissolve
C)To take one tablet every 5 minutes until the chest pain goes away
D)That it should "burn" when placed under the tongue or it is no longer effective

Question 27

Because of their site of action, bile acid sequestering resins:

A)Should be administered separately from other drugs by at least four hours
B)May increase the risk for bleeding
C)Both 1 and 2
D)Neither 1 nor 2

Question 28

Which formulation of nitrate is appropriate for acute anginal pain?

A)Transdermal
B)Sublingual
C)Oral extended release
D)Ointment

Question 29

Which of the following diagnostic results would NOT indicate a problem related to a reductase inhibitor?

A)Elevated serum transaminase
B)Increased serum creatinine
C)Elevated creatinine kinase
D)Increased white blood cell count

Question 30

How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients:

A)Have a reduced rate of renal progression, but ACE medications still need to be discontinued when advanced renal issues are present
B)Who start these medications never progress to renal nephropathy
C)Who have early renal dysfunction will see it reverse when on ACE medications
D)Without renal issues are the only ones who benefit from ACE protection

Question 31

What dermatological issue is linked to Amiodarone use?

A)Increased risk of basal cell carcinoma
B)Flare up of any prior psoriasis problems
C)Development of plantar warts
D)Progressive change of skin tone toward a blue spectrum

Question 32

Direct renin inhibitors have the following properties. They:

A)Are primarily generic drugs
B)Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy
C)Can be used with ACE and ARB medications for stronger impact
D)"Shut down" the entire RAAS cycle

Question 33

Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct.

A)Reductase inhibitors, due to an increased risk for rhabdomyolysis
B)Bile-acid sequestering resins, due to interference with folic acid absorption
C)Grapefruit juice, due to interference with metabolism
D)Calcium channel blocker, due to decreased gemfibrozil activity

Question 34

Colestipol comes in a powdered form. The patient is taught to:

A)Take the powder dry and follow it with at least eight ounces of water
B)Take it with a meal to enhance its action on fatty food
C)Mix the powder with four to six ounces of milk or fruit juice
D)Take after the evening meal to coincide with cholesterol synthesis

Question 35

Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:

A)Become a vegetarian because this disorder is associated with eating red meat.
B)Stop taking the drug if abdominal cramps and diarrhea develop.
C)Report muscle weakness or tenderness and dark urine to his provider immediately.
D)Expect "hot flash" sensations during the first 2 weeks of therapy.

Question 36

Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why?

A)Increased risk of priapism
B)Profound hypotension
C)Development of blue discoloration to the visual field
D)Inactivation of the ED medication effect

Question 37

Because of the pattern of cholesterol synthesis, reductase inhibitors are given:

A)In the evening in a single daily dose
B)Twice daily in the morning and the evening
C)With each meal and at bedtime
D)In the morning before eating

Question 38

Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient’s hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the following drugs with research efficacy should be substituted?

A) Statins
B) Fibrates
C) Omega-3 supplements
D) 1 or 2

Question 39

Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?

A)Reactive airway disease/asthma
B)Inflammatory bowel disease
C)Allergy to aspirin
D)Gallbladder disease

Question 40

Niaspan is less likely to cause which side effect that is common to niacin?

A)Gastrointestinal irritation
B)Cutaneous flushing
C)Dehydration
D)Headaches